Preoperative Magnetic Resonance and Intraoperative Ultrasound Fusion Imaging for Real-Time Neuronavigation in Brain Tumor Surgery

F. Prada, M. Del Bene, L. Mattei, L. Lodigiani, S. Debeni, V. Kolev, I. Vetrano, L. Solbiati, G. Sakas, F. Dimeco

Research output: Contribution to journalArticle

Abstract

Purpose: Brain shift and tissue deformation during surgery for intracranial lesions are the main actual limitations of neuro-navigation (NN), which currently relies mainly on preoperative imaging. Ultrasound (US), being a real-time imaging modality, is becoming progressively more widespread during neurosurgical procedures, but most neurosurgeons, trained on axial computed tomography (CT) and magnetic resonance imaging (MRI) slices, lack specific US training and have difficulties recognizing anatomic structures with the same confidence as in preoperative imaging. Therefore real-time intraoperative fusion imaging (FI) between preoperative imaging and intraoperative ultrasound (ioUS) for virtual navigation (VN) is highly desirable. We describe our procedure for real-time navigation during surgery for different cerebral lesions. Materials and Methods: We performed fusion imaging with virtual navigation for patients undergoing surgery for brain lesion removal using an ultrasound-based real-time neuro-navigation system that fuses intraoperative cerebral ultrasound with preoperative MRI and simultaneously displays an MRI slice coplanar to an ioUS image. Results: 58 patients underwent surgery at our institution for intracranial lesion removal with image guidance using a US system equipped with fusion imaging for neuro-navigation. In all cases the initial (external) registration error obtained by the corresponding anatomical landmark procedure was below 2mm and the craniotomy was correctly placed. The transdural window gave satisfactory US image quality and the lesion was always detectable and measurable on both axes. Brain shift/deformation correction has been successfully employed in 42 cases to restore the co-registration during surgery. The accuracy of ioUS/MRI fusion/overlapping was confirmed intraoperatively under direct visualization of anatomic landmarks and the error was <〈3mm in all cases (100%). Conclusion: Neuro-navigation using intraoperative US integrated with preoperative MRI is reliable, accurate and user-friendly. Moreover, the adjustments are very helpful in correcting brain shift and tissue distortion. This integrated system allows true real-time feedback during surgery and is less expensive and time-consuming than other intraoperative imaging techniques, offering high precision and orientation.

Original languageEnglish (US)
Pages (from-to)174-186
Number of pages13
JournalUltraschall in der Medizin
Volume36
Issue number2
DOIs
StatePublished - Apr 1 2015

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Neuronavigation
Brain Neoplasms
Ultrasonography
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Brain
Patient Navigation
Anatomic Landmarks
Neurosurgical Procedures
Craniotomy
Tomography

Keywords

  • brain
  • intraoperative
  • surgery
  • tumor
  • ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Preoperative Magnetic Resonance and Intraoperative Ultrasound Fusion Imaging for Real-Time Neuronavigation in Brain Tumor Surgery. / Prada, F.; Del Bene, M.; Mattei, L.; Lodigiani, L.; Debeni, S.; Kolev, V.; Vetrano, I.; Solbiati, L.; Sakas, G.; Dimeco, F.

In: Ultraschall in der Medizin, Vol. 36, No. 2, 01.04.2015, p. 174-186.

Research output: Contribution to journalArticle

Prada, F, Del Bene, M, Mattei, L, Lodigiani, L, Debeni, S, Kolev, V, Vetrano, I, Solbiati, L, Sakas, G & Dimeco, F 2015, 'Preoperative Magnetic Resonance and Intraoperative Ultrasound Fusion Imaging for Real-Time Neuronavigation in Brain Tumor Surgery', Ultraschall in der Medizin, vol. 36, no. 2, pp. 174-186. https://doi.org/10.1055/s-0034-1385347
Prada, F. ; Del Bene, M. ; Mattei, L. ; Lodigiani, L. ; Debeni, S. ; Kolev, V. ; Vetrano, I. ; Solbiati, L. ; Sakas, G. ; Dimeco, F. / Preoperative Magnetic Resonance and Intraoperative Ultrasound Fusion Imaging for Real-Time Neuronavigation in Brain Tumor Surgery. In: Ultraschall in der Medizin. 2015 ; Vol. 36, No. 2. pp. 174-186.
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abstract = "Purpose: Brain shift and tissue deformation during surgery for intracranial lesions are the main actual limitations of neuro-navigation (NN), which currently relies mainly on preoperative imaging. Ultrasound (US), being a real-time imaging modality, is becoming progressively more widespread during neurosurgical procedures, but most neurosurgeons, trained on axial computed tomography (CT) and magnetic resonance imaging (MRI) slices, lack specific US training and have difficulties recognizing anatomic structures with the same confidence as in preoperative imaging. Therefore real-time intraoperative fusion imaging (FI) between preoperative imaging and intraoperative ultrasound (ioUS) for virtual navigation (VN) is highly desirable. We describe our procedure for real-time navigation during surgery for different cerebral lesions. Materials and Methods: We performed fusion imaging with virtual navigation for patients undergoing surgery for brain lesion removal using an ultrasound-based real-time neuro-navigation system that fuses intraoperative cerebral ultrasound with preoperative MRI and simultaneously displays an MRI slice coplanar to an ioUS image. Results: 58 patients underwent surgery at our institution for intracranial lesion removal with image guidance using a US system equipped with fusion imaging for neuro-navigation. In all cases the initial (external) registration error obtained by the corresponding anatomical landmark procedure was below 2mm and the craniotomy was correctly placed. The transdural window gave satisfactory US image quality and the lesion was always detectable and measurable on both axes. Brain shift/deformation correction has been successfully employed in 42 cases to restore the co-registration during surgery. The accuracy of ioUS/MRI fusion/overlapping was confirmed intraoperatively under direct visualization of anatomic landmarks and the error was <〈3mm in all cases (100{\%}). Conclusion: Neuro-navigation using intraoperative US integrated with preoperative MRI is reliable, accurate and user-friendly. Moreover, the adjustments are very helpful in correcting brain shift and tissue distortion. This integrated system allows true real-time feedback during surgery and is less expensive and time-consuming than other intraoperative imaging techniques, offering high precision and orientation.",
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AU - Debeni, S.

AU - Kolev, V.

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